Serum sodium and hydration status predict transplant-free survival independent of MELD score in patients with cirrhosis


Associate Professor Edward J Gane, New Zealand Liver Transplant Unit, Auckland City Hospital, Private Bag 92024, Auckland 1142, New Zealand. Email:


Background and Aim:  Serum sodium may have prognostic value in addition to the model for end-stage liver disease (MELD) score for prediction of early mortality in patients listed for liver transplant. In patients with cirrhosis, over-hydration is a common feature but its prognostic value has not been evaluated. This study examines the independent prognostic significance of MELD, serum sodium and hydration status on long-term survival in patients with cirrhosis.

Methods:  Serum sodium and hydration (total body water as a percentage of fat-free mass) were measured in 227 consecutive cirrhotic patients (146 male, 81 female; median age 49 years, range 19–73 years; median MELD score 13, range 6–36). Patients with hepatocellular carcinoma or listed for liver transplantation at the time of initial assessment were excluded. A competing risks Cox proportional hazards analysis was performed to evaluate the influence of MELD, sodium and hydration on risk of death or transplant.

Results:  Median follow-up was 52 (range 4–93) months. Serum sodium and hydration were each associated with reduction in time to death or transplant on univariate analysis (sodium: hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.87–0.94, P < 0.0001; hydration: HR 1.20, 95% CI 1.10–1.30, P < 0.0001). On multivariate analysis, MELD, serum sodium and hydration were independently predictive of death or transplant (MELD: HR 1.12, 95% CI 1.06–1.19, P < 0.0001; sodium: HR 0.93, 95% CI 0.87–0.99, P = 0.04; hydration: HR 1.17, 95% CI 1.02–1.33, P = 0.02).

Conclusions:  In non-waitlisted patients with cirrhosis, serum sodium is predictive of transplant or death independent of MELD score.